Expert: Doctor Early Options - 2/20/2009

Question
QUESTION: Doctor,
Iam from U.A.E. I had a medical termination of pregnancy on the 49th day of my pregnancy on 23rd December 2008 using Mifepreston and Misoprostol. Upon taking Mifepreston on 23rd Morning, about 2 hours later I vomited and I was doubtful if the tablet would have expelled. Upon consultation with a Doctor I took Misoprostol on the 24th midnight, and had heavy bleeding on 25th early morning until noon and by evening it became as normal as a menstrual period, this continued for another 3 days.
Further, reddish spotting was observed frequently for about 3 weeks. Then upon consultation with doctor and further scanning, doctor advised to have a D & C for having found to have a small dead particle remaining in the Uterus. I was afraid to undergo a D & C and instead I arranged to get 400 mg Misoprostol and decided to attempt a second try. I took the medicine on the 27th January in the night and on the 28th morning I started to have a heavy bleeding that continued until the evening. The bleeding was so heavy and many times blood clots of the size of an orange was expelled out which lasted until the evening. From the next day normal bleeding continued for a week, and last week the blood clots reduced in quantity but appeared on frequent interval in dark brownish colour. Now since last couple of days the spots have reduced much more and appear to be light brown and some times while washing the vagina, thin brownish thread like blood clots were found. Now I am on the 15th day after the administration of 2nd doze of Misoprostol. I am still afraid to go back to doctor to hear that I need to undergo a D & C. I need your expert opinion in my case to know if there is still a chance of having particle remaining in my uterus and if there is any way to completely stop the bleeding and to have my menstrual cycle back.


ANSWER: Dear Fana,
This sounds like a very difficult experience with the abortion pill. The good news is that it sounds like you had a successful medical abortion, even though it did not completely pass. It sounds like the second dose of misoprostol helped to expel what was remaining.
If the pregnancy is over, which has been confirmed, there is no medical necessity for doing a D&C.  Whatever tissue is remaining either has aleady passed or will pass on its own.  You may continue to have some bleeding, spotting, or brown discharge, or even clots.  The most important thing is for you to be reassured that your period will come back to normal in the next few months, and that there is absolutely nothing wrong.  
I hope this is helpful,
Doctor Joan
EarlyAbortionOptions.com
New York City

---------- FOLLOW-UP ----------

QUESTION: Dear Doctor Joan,
I really got a new energy to wait for my normal life to be back with your reply on 11th Feb. Since then I experienced a drastic reduction in the blood spots and bleeding which reduced to once or twice a day and that too in a very small quantity in brownish color. But from last 2 days the blood spots changed to fresh bleeding more frequent than it was during the last week, but not so heavy bleeding.
I expect to have your advise at this stage.

Answer
Dear Fana,
There is nothing to worry about.  This is completely normal for the bleeding to come and go like this.  It could be your period, or it could still be hormonal, from the pills.  It sound like the heavy bleeding is over, and you are now experiencing irregular bleeding, which is expected.  This kind of irregular bleeding can go on for weeks to months after a medical abortion, and is completely normal, and nothing to worry about.  Your cycles will come back to normal.
I hope this is helpful,
Doctor Joan
EarlyAbortionOptions.com
New York City